Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA; Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA; Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Nutrition. 2018 Sep;53:77-84. doi: 10.1016/j.nut.2018.01.006. Epub 2018 Feb 13.
Dietary diversity (DD) measures dietary variation in children. Factors at the child, community, and state levels may be associated with poor child nutritional outcomes. However, few studies have examined the role of macro-level factors on child DD. This study seeks to 1) describe the distribution of child DD in India, 2) examine the variation in DD attributable to the child, community and state levels, and 3) explore the relationship between community socioeconomic context and child DD.
Using nationally representative data from children aged 6-23 months in India, multilevel models were used to determine the associations between child DD and individual- and community-level factors.
There was substantial variation in child DD score across demographic and socioeconomic characteristics. In an age and sex-only adjusted regression model, the largest portion of variation in child DD was attributable to the child level (75%) while the portions of variance attributable to the community-level and state level were similar to each other (15% and 11%). Including individual-level socioeconomic factors explained 35.6 percent of the total variation attributed to child DD at the community level and 24.8 percent of the total variation attributed to child DD at the state level. Finally, measures of community disadvantage were associated with child DD in when added to the fully adjusted model.
This study suggests that both individual and contextual factors are associated with child DD. These results suggest that a population-based approach combined with a targeted intervention for at-risk children may be needed to improve child DD in India.
饮食多样性（DD）衡量儿童的饮食变化。儿童、社区和州各级的因素可能与儿童营养不良结果有关。然而，很少有研究探讨宏观因素对儿童 DD 的影响。本研究旨在：1）描述印度儿童 DD 的分布情况；2）检查 DD 因儿童、社区和州各级而异的情况；3）探讨社区社会经济环境与儿童 DD 之间的关系。
本研究使用了印度 6-23 个月儿童的全国代表性数据，使用多水平模型确定儿童 DD 与个体和社区水平因素之间的关联。
儿童 DD 评分在人口统计学和社会经济特征方面存在很大差异。在仅按年龄和性别调整的回归模型中，儿童 DD 的最大变异部分归因于儿童自身（75%），而归因于社区和州级别的变异部分相似（分别为 15%和 11%）。包括个体社会经济因素在内，解释了社区层面儿童 DD 总变异的 35.6%，州层面儿童 DD 总变异的 24.8%。最后，在加入完全调整模型后，社区劣势的衡量指标与儿童 DD 相关。
本研究表明，个体和环境因素都与儿童 DD 有关。这些结果表明，可能需要采取基于人群的方法结合针对高危儿童的靶向干预措施，以改善印度儿童 DD 的状况。
